Anterior Interosseous Nerve Syndrome

Anterior Interosseous Nerve Syndrome

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What is Anterior Interosseous Nerve Syndrome?

Anterior Interosseous Nerve (AIN) Syndrome is a rare condition affecting the motor function of the forearm. It involves the compression or injury of the AIN, a branch of the median nerve, leading to weakness in specific muscles without sensory loss. This syndrome primarily manifests through difficulty in performing precise thumb and finger movements, significantly impacting hand function.

Anterior Interosseous Nerve Syndrome Statistics

  • AIN syndrome accounts for approximately 1% of all upper extremity nerve palsies.
  • Recovery rates are higher when treatment, especially surgery, is initiated within 8 months of symptom onset.
  • Source: Radiopaedia

    • Anterior Interosseous Nerve Syndrome Anatomy

  • The Anterior Interosseous Nerve (AIN) is a branch of the median nerve, originating in the proximal forearm.
  • AIN innervates the following muscles: Flexor pollicis longus (FPL), the lateral half of Flexor digitorum profundus (FDP), and Pronator quadratus (PQ).
  • The nerve runs along the interosseous membrane alongside the anterior interosseous artery.

    • Anterior Interosseous Nerve Syndrome
    Signs & Symptoms

  • Motor deficits only: No sensory complaints.
  • Pain in the forearm and cubital fossa.
  • Weakness in thumb and index finger: Difficulty with the "OK" sign (Pinch Grip test).
  • Difficulty forming a fist or buttoning shirts.

    • Causes of Anterior Interosseous Nerve Syndrome

  • Traumatic causes: Forearm fractures, penetrating injuries, cast fixation, and venipuncture.
  • Spontaneous causes: Brachial plexus neuritis, compartment syndrome, and compression neuropathy.
  • Compression: Most commonly at the tendinous edge of the pronator teres muscle.

    • Risk Factors for Anterior Interosseous Nerve Syndrome

  • Rheumatoid arthritis and gout: Can predispose to AIN entrapment.
  • Forearm injuries: Increase the likelihood of AIN compression.
  • Post-surgical complications: Such as after open reduction and internal fixation of fractures.

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    Prevalence of Anterior Interosseous Nerve Syndrome

  • AIN syndrome is rare: Comprising only 1% of all upper extremity palsies.
  • More common in certain populations: Including those with a history of trauma or inflammatory conditions.

    • Assessment & Diagnosis of Anterior Interosseous Nerve Syndrome

  • Electrodiagnostic studies: Essential to diagnose AIN syndrome, showing abnormalities in FPL, FDP, and PQ muscles.
  • MRI: Useful for evaluating possible compression sites and other pathologies.
  • Pinch Grip test (Froment’s sign): Key clinical test for AIN syndrome, assessing the ability to form an "OK" sign.

    • Rehabilitation & Physiotherapy for Anterior Interosseous Nerve Syndrome

  • Nerve mobilization exercises: To enhance nerve glide and reduce symptoms.
  • Stretching exercises: Focus on the forearm flexor muscles.
  • Electrical stimulation: TENS or NMES to stimulate affected muscles.
  • Strengthening exercises: Targeting the hand and wrist to regain functional strength.

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    Anterior Interosseous Nerve Syndrome FAQs

    The most common cause of AIN syndrome is compression neuropathy, often at the pronator teres muscle, leading to motor deficits in the forearm and hand.

    Yes, many cases can be managed with conservative treatment, including rest, anti-inflammatory medications, and physiotherapy. Surgery is considered if there is no improvement after several months.

    Diagnosis is typically made through electrodiagnostic studies and clinical tests like the Pinch Grip test, often supplemented by MRI to identify any compressive lesions.

    Anterior Interosseous Nerve Syndrome References

  • Radiopaedia - Anterior Interosseous Nerve Syndrome
  • StatPearls - Anterior Interosseous Syndrome
  • ScienceDirect - Anterior Interosseous Nerve Syndrome Case Report

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